Periodontal Gingival Enlargement

1. Good Afternoon
IVth Year
Good Afternoon
IVth Year

2. GINGIVAL
ENLARGEMENT

3. INTRODUCTION
Oral mucosa is constantly subjected to external and
internal stimuli and therefore manifests a spectrum of
diseases that range from developmental, reactive,
inflammatory to neoplastic.
The most frequently encountered oral mucosal lesions
in humans are the reactive hyperplastic lesions.

4. Gingival enlargement a common feature of gingival disease which can
be caused by gingival inflammation, fibrous overgrowth, or a
combination of the two.
It is a multifactorial condition that develops as interactions between the
host and the environment or in response to various stimuli.
INTRODUCTION

5. It may be plaque–induced, associated with systemic
hormonal disturbances or occur as a manifestation
associated with several blood dyscrasias, such as
leukaemia, thrombocytopenia or thrombocytopathy.
These enlargements may lead to functional
disturbances like difficulty in mastication, altered
speech, aesthetic and psychological problems.
INTRODUCTION

6. The ability to perform oral hygiene measures is compromised
in some patients with gingival enlargements, which may be
further complicated by the presence of prosthesis and fixed
orthodontic appliances.
This may lead to more inflammation and further plaque
accumulation perpetuating this vicious cycle. Thus, there is a
transformation of the gingival sulcus into a periodontal pocket
creating an area where plaque removal becomes impossible.
INTRODUCTION

7. CLASSIFICATIONCLASSIFICATIONCLASSIFICATION

8. CLASSIFICATION
INFLAMMATORY
Chronic
Acute
DRUG-INDUCED
Anticonvulsants
Calcium channel blockers
Immunosuppressant
CLASSIFICATION

9. ASSOCIATED WITH SYSTEMIC DISEASES OR CONDITIONS
Conditions :
Pregnancy
Puberty
Vitamin C deficiency
Plasma cell gingivitis
Nonspecific conditional enlargement (pyogenic granuloma)
Diseases :
Leukaemia
Granulomatous diseases
NEOPLASTIC ENLARGEMENT
FALSE ENLARGEMENT
CLASSIFICATIONCLASSIFICATION

10. INFLAMMATORY
ENLARGEMENT
Chronic Inflammatory Enlargement
Slight Ballooning of the interdental papilla and/or marginal
gingiva.
Bulge increases in the size until it covers part of the Crown.

11. GINGIVAL CHANGES ASSOCIATED
WITH MOUTH BREATHERS
• Common site : Maxillary Anterior region.
• Gingiva : Red and oedematous, with a diffuse surface
shininess of the exposed area.

13. ACUTE INFLAMMATORY
ENLARGEMENT
Gingival Abscess

14. Drug Induced
Gingival
Enlargement
Drug Induced
Gingival
Enlargement

15. DRUG INDUCED
GINGIVAL ENLARGEMENT
Anticonvulsants
Immunosuppressants
Calcium Channel Blockers

17. PHENYTOIN INDUCED
GINGIVAL ENLARGEMENT
In the maxilla, note the bulbous papillary enlargement, leaving a
trough between enlarged papillae, and a pink, stippled surface.

18. CYCLOSPORIN ASSOCIATED
GINGIVAL ENLARGEMENT
• Growth starts in inter-proximal papillae.
• More frequent in anterior facial areas, partially covering the crowns.
• Little bleeding tendency +nt.

19. IDIOPATHIC GINGIVAL
ENLARGEMENT
Etiology : Unknown
Affected area : Attached gingival, marginal and
internal gingiva.
Common Region : Facial and Lingual Areas of
Mandibular Region.
Surface : Pebbled.

21. ENLARGEMENT
ASSOCIATED
WITH
SYSTEMIC DISEASES/
CONDITIONS

22. PREGNANCY
• Marginal gingival enlargement during pregnancy results from the
aggravation of previous inflammation.
• May be diffuse and generalized with red, smooth shiny surface soft and
friable. Or appear as discrete, mushroom like, flattened spherical mass,
sessile or pedunculated.
• Usually painless unless ulcerated by trauma.

23. ENLARGEMENT IN
PUBERTY
• Marginal/interdental characterised by prominent bulbous inter-proximal papillae.
• Only the facial gingiva are involved.
• Tendency to develop massive recurrence.
• After puberty the enlargement undergoes spontaneous reduction but does not
disappear until all local irritants are removed.

24. LEUKAEMIA
•Diffuse/marginal, localised/generalised.
•Gingiva is generally bluish red and has a shiny surface.
•Tendency towards friability and haemorrhage.

25. NEOPLASTIC
ENLARGEMENT
Giant Cell
Granuloma
• Most frequently seen on
labial surface.
• Sessile/pedunculated.
• Lesions are painless, can
cover several teeth.
• Firm/spongy.
• Pink to deep red or
purplish blue in colour.

26. OTHER NEOPLASTIC
ENLARGEMENTS
Pyogenic
Granuloma
Base : Broad
Pus : Absent
Tissue :
Granulation tissue.

27. PAPILLOMA
• Originating from
s u r f a c e
epithelium.
• M o s t c o m m o n
Lesion.
• May be associated
with HPV.
• Is an exophytic
growth made up
o f n u m e r o u s
small finger like
projections.

28. CARCINOMA :
SQUAMOUS CELL
•Exophytic /
verrucous,
outgrowths /
ulcerations.
•Locally invasive.
•Asymptomatic
•Metastasis is
common above
clavicle.

29. FALSE ENLARGEMENT
•Appear as a result of increase in size of underlying osseous
or dental tissues.
•Enlargement of the bone (tori, exostoses, Paget’s disease,
fibrous dysplasia).
•Developmental enlargement (labial gingiva shows distortion
due to superimposition of the gingiva on enamel in the
gingival half of crown).

31. TREATMENT
Elimination of Etiologic cause.
Discontinuing of the Etiologic Drugs.
Gingivectomy
Flap Surgery associated with Gingivectomy.